ch.35 bone disorders Flashcards
Identify these diseases:
- loss of bone mass and skeletal fragility; causes morbidity; most pronounced in postmenopausal women.
- bone remodeling , misshapen or enlarged bones; limited to 1 or few bones; bone pain ,deformities, fractures
- softening of bones; attributed to vitamin D defieciency
- Osteoporosis
- Paget’s disease
- Osteomalcia
Osteomalcia in children is referred to as ?
Rickets
function osteoCLASTS and osteoBLASTS?
CLASTS: break down bone
BLASTS: “bone-building cells”
purpose of bone mineralization? attributed to ?
how does bone loss occur?
mineralization essential for bone strenght; attributed from hydroxyapatite (calcium phosphate)–>deposit in bone matrix
bone loss : bone resporption (process: bone breakdown- osteoclasts) exceeds bone formation during remodeling process
bone resportion
bone break down process (osteoclasts)
glucocorticoids increase loss or gain?
-prednisone 5mg/day 3 months risk factor?
bone loss
-risk for osteoporosis
reducing bone loss in postmenopausal women?
intake of calcium and vit D, weight bearing exercises , smoking cessation
alendronate, ibandronate, risedronate, zoledronic acid along with etidronate, pamidronate, tiludronate are ?
bisphosphoNATES
- postmenopausal osteoporosis
- Paget’s disease
- bone metastases and hypercalcemia of malignancy
MOA of bisphosphonates:
-first line drugs for treatment of osteoporosis
decrease osteoclastic bone resorption; increase of osteoclastic apoptosis and inhibition of cholesterol biosynthetic pathway important for osteoclast function
beneficial effects of which drugs persist over several years of therapy , but discontinuation results in a gradual loss of effects?
aledronate
- avidly bind to hydroxyapatite in bone
- should be avoided in severe renal impairment
bisphosphonates
-alendronate, risedronate, ibandronate
when oral bisphosphanates are not tolerated we use which IV bisphosphanates?
ibandronate
zoledronic acid
associated with esphagitits and esophageal ulcers.
-pt should remain upright for 60min after taking oral bisphonates
alendronate,risdronate,ibandronate
osteonecrosis is associated with
intravenous doses used for hypercalcemia of malignancy.
-bisphosphonates
bisphosphonate that causes ostemalacia after long term use ?
Etidronate
after menopause what promotes proliferation and activation of osteoclasts?
low estrogen levels
effective for the prevention ofmpostmenopausal bone loss
estrogen
increases the risk of endometrial cancer, breast cancer, stroke, VENOUS THROMBOLISM , coronary events
estrogen
selective estrogen receptor modulator approved for the treatment of osteoporosis
-reduces levels of total and low density lipoprotein cholesterol
raloxifene
hot flashes, leg cramps, risk of venous thrombolism are adverse effects of
raloxifene
2nd line treatment osteoporosis in postmenopausal women who are at least 5 years postmenopausal
calcitonin
it reduces bone resporption, but less effective than bisphosphonates
- relief of pain associated with osteoporotic fractures, recent vertebral fractures
- intranasal or parental formulation (rarely used in osteoporosis treatmente IV)
calcitonin
rhinitis and other nasal symptoms are adverse effects of
calcitinonin
resistance to calcitonin , obeserved in long term use for which disease?
Paget’s disease
monoclonal antibody that targets receptor activator of nuclear factor Kappa- B ligand and inhibits osteoclast formation and function
- post menopausal osteoporosis for women at high risk of fracture
- subcutaneous injections every 6 months
denosumab
postmenopausal osteoporosis drug associated with adverse effects of infection, hypocalcemia, osteonecrosis of the jaw, atypical fractures
denosumab
a recombinant form of human parathyroid hormone
- subcutanous daily
- treats osteoporosis
teriparatide
First approved treatment for osteoporosis that stimulates bone formation (osteoblastic activity).
-associated for patients with high risk fracture
teriparatide
